Department of the Interior and Local Government Form CM 3.

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Assessment for the Seal of Good Local Governance (Cities/Municipalities) Social Protection and
CY 2024 Sensitivity

Seal of Good Local Governance – REGIONAL ASSESSMENT

Form CM 3.3 Social Protection and Sensitivity

City/Municipality of : Income Class :

Province : Region :

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS.

For the RAT Members
1) Based on your thorough review of documents provided by the assigned DILG Field Officers and on-site visit, please supply the
required information or tick applicable LGU condition under Column A. (2) Please refer to the NGA data provided by the BLGS for
indicators/items with N. (3) In case of a correction/erasure, the RAT leader must affix a signature parallel to the corrected
portion. (4) AFFIX SIGNATURE AT THE END OF EACH ASSESSMENT AREA, and PUT INITIALS AT THE BOTTOM OF EACH PAGE.
ONLY DULY ACCOMPLISHED FORMS ARE TO BE ENCODED BY THE RFP OR PFP.

Required data LGU condition

Protection and Access to Justice of Women and Children

1(N) The LGU is a 2023 Seal of Child-friendly Local
Governance recipient(please tick as appropriate) Yes
No
Not yet available

If not a recipient, please supply the following

information

1.1a (N) Passing rate of LGU (please supply

information)

1.1b (N) Rating for each category (please indicate

percentages)

Survival(please supply information)

Development(please supply information)

Protection(please supply information)

Participation(please supply information)

Governance(please supply information)

1.2 (N) Compliant with CFLGA indicators on: (please [ Local Code for Children
tick as appropriate) ]
[ Implemented plans for children
]
[ Budget allocation and utilization for PAPs for children
]

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2 The LGU has mechanisms in support of gender and
development

2.1 GAD Focal point system(please tick as appropriate) Present

Not present

2.2 GAD database(please tick as appropriate) Present

Not present

2.3 CY 2023 GAD accomplishment report(please tick as Present

appropriate) Not present

2.4 GAD Code

a. Updated City / Municipal Code(please tick as Yes

appropriate) No

Date adopted (dd/mm/yyyy)(please supply

information)

b. Passed ordinance(s) amending / revising existing Yes

Code(please tick as appropriate) No

Date passed (dd/mm/yyyy(please supply

information)

c. Localized Provincial GAD code(please tick as Yes

appropriate) No

If yes, please indicate date of adoption of

Provincial Code (dd/mm/yyyy)

2.5.a CY 2023 GAD Plan and Budget (please tick as
appropriate)
Reviewed and was found fully compliant in form and
content per PCW-DILG-DBM-NEDA JMC No. 2016-01
(based on accomplished Form CM 2E: DILG Field Office)
Submitted to DILG Field Officer for review
None of the above

2.5.b CY 2024 GAD Plan and Budget(please tick as Reviewed and was found fully compliant in form and
appropriate) content per PCW-DILG-DBM-NEDA JMC No. 2016-01
(based on accomplished Form CM 2E: DILG Field Office)
Submitted to DILG Field Officer for review
None of the above

2.6 CY 2023 GAD Accomplishment

a. Fund Disbursement Rate (based on accomplished

Form CM 2A: Accountant's Office)

Amount allocated (please supply information)

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 Amount disbursed(please supply information)

Percent disbursement (please supply information)

b. Completion rate of PPAs (based on accomplished

Form CM 2H Planning and Development Office)
(please supply information)

3. The LGU has mechanisms in support of efforts against

trafficking and violence against women and their
children (VAWC)

3.1 Organized Local Committee on Anti-Trafficking and Yes

Violence Against Women and their Children (LCAT- No
VAWC)(please tick as appropriate)

3.2 Conducted quarterly meetings of LCAT-VAWC [ 1st quarter of 2023

(please tick all applicable items) ]
[ 2nd quarter of 2023
]
[ 3rd quarter of 2023
]
[ 4th quarter of 2023
]
[ None of the above
]

3.3 Percentage of barangays with respective VAW desks

(based on accomplished Form CM 2J: SWD Office)
(please supply information)

3.4 Percentage of barangays with submitted quarterly

reports for CY 2023

CY 2023 - 1st quarter(please supply information)

CY 2023 - 2nd quarter(please supply information)

CY 2023 - 3rd quarter(please supply information)

CY 2023 - 4th quarter(please supply information)

4. (N) The LGU has implemented the Supplementary

Feeding Program Cycle 12 (please tick as appropriate) Yes
No
Not applicable

If Yes, please provide accomplishment rate as of

December 31, 2023

Accessibility for Persons with Disabilities and Older

Persons
5 The LGU has physical features and a local office
promoting accessibility for Persons with Disabilities
(PWDs) and Older Persons

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5.1 City/Municipal Hall (please tick as appropriate) [ Not a historical site/under construction
]
[ Historical Site
]
[ Under construction
]

Based on the Photo Documentation and Information [ Ramps

in Certified Form 2G Engineering Office. The LGU ]
complied with BP 344 requirements in the following: [ Toilet
(please tick as appropriate) ]
[ Signages
]
[ Parking space for persons with disabilities
]
[ None of the above
]

If under construction, LGU has a facility or building Yes

catering to all PWD-related concerns or services and No
construction plans include the provision of ramps
with 2-level handrails(please tick as appropriate)

5.2 Main health facility(please tick as appropriate) [ Not a historical site/under construction
]
[ Historical Site
]

Based on the Photo Documentation and Information [ Stairs (if applicable)

in Certified Form 2G Engineering Office. The LGU ]
complied with BP 344 requirements in the following: [ Walkways
(please tick as appropriate) ]
[ Corridors
]
[ Doors and building entrance
]
[ Washrooms and toilets
]
[ Ramps
]
[ Parking space for persons with disabilities
]
[ Switches, Controls, Buzzers
]
[ Handrails
]
[ Floor Finishes
]
[ Drinking/Water fountains
]
[ Public telephone
]
[ Seating accommodations
]
[ Signages
]
[ Elevator (if applicable)
]
[ None of the above
]

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 Copy of plan to be implemented in the next 2 years Stand-alone plan
(in case minimum requirements on health facility Integrated in approved CDP, LIPH, LDIP, AIP, or annual
could not be complied with)(please tick as budget.
appropriate)

5.3 Tertiary Education Facility / TVET Center (please [ Not a historical site/under construction
tick as appropriate) ]
[ Historical Site
]
[ Under construction
]
[ No Tertiary Education Facility / TVET Center
]

Based on the Photo Documentation and Information [ Ramps

in Certified Form 2G Engineering Office. The LGU ]
complied with BP 344 requirements in the following: [ Toilet
(please tick as appropriate) ]
[ Signages
]
[ Parking space for persons with disabilities
]
[ None of the above
]

If under construction, LGU has a facility or building Yes

catering to all PWD-related concerns or services and No
construction plans include the provision of ramps
with 2-level handrails(please tick as appropriate)

6. The LGU has a local office that heads programs /

projects / activities for PWDs

Persons with Disability Affairs Office (PDAO)(please tick [ Established office through an Ordinance
all applicable items) ]
[ Established office through an Executive Order
]
[ Appointed PDAO Head who is PWD
]
[ Appointed PDAO Head who is not PWD
]
[ No PDAO
]

PDAO is headed by:

a. Position title(please supply information)

b. Salary Grade (please supply information)

c. Nature of appointment (please tick as Permanent

appropriate) Temporary
Designated

In case appointment is temporary, period has Yes

not exceeded one year(please tick as No
appropriate)

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 d. Status of appointment(please tick as [ With affixed signature of CSC Field Office (FO)
appropriate) ] representative
[ Approved by LGU accredited to take final action on
] appointments thru CSC Resolution
[ Copy is transmitted to CSC for attestation
]
[ Executive Order or similar document is issued for
] designation

If copy has been transmitted for attestation,

please indicate date received by the CSC:

If an Executive Order or similar document was

issued for designation, please indicate date of
approval:

e. Date of appointment(please supply information)

PDAO Head recruitment process(please tick all that [ General assembly (GA) with the PWD sector was held
apply) ]
[ GA nominated at least 3 qualified applicants (for C/M
] only)
[ Personnel Selection Board (PSB) included participant
] from the PWD sector (for C/M only)

If PWD sector was represented in PSB [ LGU employee with disability

proceedings, participant was(please tick all that ]
apply) [ GA-nominated observer
]

PDAO has accomplished the following (please tick all [ Accomplishment Report of PWD-related PPAs indicating
applicable items) ] at least 75% budget utilization (disbursement) or
completion of PPAs
[ All issued IDs uploaded in the DOH PRPWD
]
[ None of the above
]
7. Presence of a Sign language interpreter in the LGU
(please tick as appropriate) [ At least one sign language interpreter in the LGU
]
[ At least one LGU staff trained in basic sign language
] assigned in the PDAO
[ LGU has allotted a budget for hiring a sign language
] interpreter
[ LGU has a list of external service providers that can be
] tapped by LGU
[ None of the above
]
8 The LGU has an established Senior Citizens Center
(SCC) based on Certified Form 2E - Photo Yes
Documentation(please tick as appropriate) No

8.1 SCC is managed by(please tick all that apply) [ LGU

]
[ DSWD - Field Office
]
[ Partner - LGU
]
[ Partner - private agency / organization
]

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 8.2 Name of SCC(please supply information)

Upholding Indigenous Peoples Representation in local

decision-making bodies
9. (N) The LGU's Indigenous People mandatory
representative(please tick all applicable items) [ Has Certificate of Affirmation issued by the NCIP
] Regional Office
[ Seats in the Sanggunian
]
[ Receives compensation and other regular benefits of a
] Sanggunian member
[ Attends Sanggunian sessions as indicated in the Minutes
] of the Meetings
[ Not applicable
]
Support to decent shelter for all and low-cost housing
10. [For Cities only] The LGU has illegal dwelling units
within its jurisdiction (based on accomplished Form Yes
2H: Planning and Development Office)(please tick as No
appropriate)

10.1 Percent accomplishment of CY 2023 targets for

resettlement PPAs (based on accomplished Form 2H:
Planning and Development Office)(please supply
information)

10.2 LGU effort(s) to control, prevent and/or remove

illegal dwelling units

Ordinance prohibiting illegal settlements, relocation Present

and/or reintegration of informal settlers(please tick Not present
as appropriate)

Has the following office or entity(please tick as [ Local Housing Board

appropriate) ]
[ Local Housing Office
]
[ Task Force
]

Approved Local Shelter Plan, or approved Present

Resettlement and Relocation Action Plan(please tick Not present
as appropriate)

If yes, timeline of plan (yyyy-yyyy)(please supply

information)

Percentage of accomplishment CY 2023

targets(please supply information)

Resettlement and relocation PPAs (please tick as Present

appropriate) Not present

Local initiatives supporting the marginalized sectors

11. The LGU accomplished PPAs / disbursed funds for
the marginalized sectors

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 11.1 Senior citizens and Person with disabilities

Fund disbursement CY 2023 (based on accomplished

Form 2A: Accountant’s Office)

a. Total amount allocated (please supply

information)

b. Amount disbursed(please supply information)

c. Percent disbursement(please supply

information)

Percent completion of PPAs (based on accomplished

Form 2H: Planning and Development Office) (please
supply information)

11.2 Local Council for the Protection of Children (LCPC),

CY 2023 Fund

Source of fund, CY 2023 (based on accomplished

Form 2A: Accountant’s Office)

a. IRA/NTA amount received(please supply

information)

b. Amount allocated (please supply information)

c. Percent allocation (please supply information)

Fund disbursement (based on accomplished Form

2A: Accountant's Office)

a. Total amount allocated (please supply

information)

b. Amount disbursed(please supply information)

c. Percent disbursement(please supply

information)

Percent completion of PAPs (based on accomplished

Form 2H: Planning and Development Office) (please
supply information)(pls. supply information)

12.(N) [For cities only] The LGU has a care facility for
the vulnerable sectors(pls. tick as appropriate) Yes
No

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 If yes, pls. supply the following information:
12.1. Type of Facility(pls. tick as appropriate)
12.2. For LGU-managed facility(pls. tick as
appropriate)
12.3 For Partner-managed facility(pls. tick as
appropriate)
Please provide period of effectivity of
accreditation:(pls. supply information)
Please provide name of partner / facility:
13. The LGU is a beneficiary of the Pantawid Pamilyang
Pilipino Program(pls. tick as appropriate
If yes, the LGU has accomplished the following:(pls. tick
as appropriate)
Functionality of the Local Social Welfare and
Development Office
14. The LGU has a Local Social Welfare and
Development Office (LSWDO)
14.1 LSWDO is headed by:
Position title (please supply information)
Salary Grade (please supply information)
Nature of appointment (please tick as appropriate)
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Residential Care Facility
Non-Residential Care Facility
(N) DSWD or BARMM MSSD-accredited
Ongoing application for DSWD or BARMM MSSD-
Accreditation
Newly-established facility, operation is less than 1-year
Not in NGA data, but LGU provided valid Certification
None of the above
DSWD - Field Office
Partner - LGU
Private Social Welfare and Development Agency
Yes
No
[ Issued a Local Ordinance supporting the 4Ps
] implementation and adopting the social case
management process and graduation/exit
services/intervention with budget allocation
[ With Budget allocation for 4Ps- related programs and
] activities for active and exited beneficiaries in the CDP,
LDIP, AIP or LPRAP in CY 2023/2024
[ At least 50% of graduated/exited beneficiaries are
] provided/facilitated with programs and services based
on agreed Exit/Intervention Plan
Permanent
Temporary
Designated
 In case plantilla position is vacant due to [ Vacancy happened within 2023 to 2024
separation from service, please tick all applicable ]
items: [ Vacated position has the prescribed SG
]
[ Efforts to hire new LSWDO is already on-going
]
[ With designated LSWDO Head in the meantime who is
] also an RSW

In case appointment is temporary, period has not Yes

exceeded one year(please tick as appropriate) No

Status of appointment(please tick as appropriate)
With affixed signature of CSC Field Office (FO)
representative
Approved by LGU accredited to take final action on
appointments thru CSC Resolution
Copy is transmitted to CSC for attestation
Executive Order or similar document is issued for
designation

If copy has been transmitted for attestation, please

indicate date received by the CSC:

If an Executive Order or similar document was

issued for designation, please indicate date of
approval:

Date of appointment (dd/mm/yyyy)(please supply

information)

Registered social worker (please tick as appropriate) Yes

No, because he/she is hired prior to the enactment of
RA 9433
Not a registered social worker

Validity of PRC license (please supply information)

14.2 Number of staff assisting the LSWDO with PRC

license (please supply information)

Validity of PRC license (please supply information for

at least one staff)

14.3 LSWDO has a procedure / manual of operations or Yes

local guidelines on case management(please tick as No
appropriate)

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 14.4 All public social workers are provided with Magna [ Hazard allowance
Carta grant benefits(please tick as appropriate) ]
[ Subsistence/Transportation Allowance
]
[ Housing and Living Quarters Allowance
]
[ Longevity pay
]
[ Clothing Allowance
]
[ None of the Above
]

14.5 Use of CBMS data or other targeting system as a Yes

registry to update the profiles of current beneficiaries of No
social development programs(please tick as
appropriate)

14.6 Efforts to implement CBMS(please tick as [ On-going CBMS data gathering

appropriate) ]
[ Proposed PAPs to implement CBMS
]
[ Use of other socioeconomic database, profiling or
] tracking/targeting system other than CBMS
[ Others
]
15. LGU efforts on mainstreaming social
protection(please tick all applicable items) [ Social Protection Development Report (SPDR) is
] available
[ SPDR of component cities and municipalities are
] submitted to the PSWDO
[ SP Initiatives from the SPDR integrated in local plans
]
[ Policy issuance on any area of recommendation of the
] SPDR
[ None of the above
]
Providing free employment facilitation services
16. The LGU has a Public Employment Service Office
(PESO)(please tick as appropriate) Established office through ordinance
Established office through Executive Order
Allocated with budget in CY 2024 Annual
budget/appropriation ordinance
No PESO due to PS limitation
No PESO but with designated officer
No PESO

16.1 PESO is headed by:

Position Title (please supply information)

Salary Grade (please supply information)

Nature of appointment (please tick as appropriate) Permanent

Temporary
Designated

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 In case appointment is temporary, period has not
exceeded one year(please tick as appropriate)
In case plantilla position is vacant due to
separation from service, please tick all applicable
items:
Status of appointment(please tick as appropriate)
If copy has been transmitted for attestation, please
indicate date received by the CSC:
If an Executive Order or similar document was
issued for designation, please indicate date of
approval and reason for designation:(please supply
information)
Date of appointment (please supply information)
Functionality of Local Development Council
17. The LGU has an organized Local Development
Council (LDC)
17.1 Composition(please tick as appropriate)
Number of LDC members(please supply information)
Number of representatives from non-government
organizations (NGOs) (please tick as appropriate)
Percentage of NGO representation(please supply
information)
Please tick applicable condition:
If less than 1/4 of LDC, please tick all applicable
items:
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Yes
No
[ Vacancy happened within 2023 to 2024
]
[ The vacated position has the prescribed SG
]
[ Efforts to hire new PESO is already on-going
]
[ With designated PESO Head in the meantime
]
With affixed signature of CSC Field Office (FO)
representative
Approved by LGU accredited to take final action on
appointments thru CSC Resolution
Copy is transmitted to CSC for attestation
Executive Order or similar document is issued for
designation
Constituted according to Sec. 107 of the LG Code
Not constituted per Sec. 107
More than ¼ of the fully organized LDC
¼ of the fully organized LDC
Less than ¼ of the fully organized LDC
[ Insufficient number of organized CSOs in the locality
]
[ Insufficient number of accredited CSOs in the locality
]
[ Others
]
 If others is ticked, please specify:

17.2 Executive Committee(please tick as appropriate) Present

Not present

17.3 Secretariat(please tick all that apply) [ Constituted

]
[ Provides technical assistance, documentation of
] proceedings, and preparation of reports
[ Tapped assistance of NGOs, academe, and / or research
] institutions

17.4a Local Project Monitoring Committee(please tick as As an organized functional committee of LDC
appropriate) As a stand-alone committee
Not present

17.4b Other Sectoral or functional committees (please [ Social development

tick all present committees) ]
[ Economic development
]
[ Physical/ land use/ infrastructure development
]
[ Environmental management
]
[ Institutional development
]
[ Others.
]

17.5a Number of meetings between January to June of

CY 2023(please supply information)

17.5b Number of meetings between July to December of

CY 2023(please supply information)

17.6 CSO participation in LDC meetings(please tick all [ Participation recorded in meeting/s held between CY
that apply) ] 2023 January to June
[ Participation recorded in meeting/s held between CY
] 2023 July to December
[ With a submitted action plan in CY 2023
]
[ None of the above
]

17.7 Sanggunian-approved/adopted plans and [ Has Comprehensive Development Plan (CDP)

investment programs that cover CY 2024 (please tick all ]
that apply) [ Has a Local Development Investment Program (LDIP)
]
[ Has an Annual Investment Plan (AIP)
]
Strengthening population services

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18. The LGU has a Population Office.(please tick as
appropriate) [ Established office through an Ordinance
]
[ Established office through an Executive Order
]
[ With appointed population officer
]
[ With designated population officer
]
[ No Population Office but with designated officer or
] coordinator
[ No Population Office
]

The Population Office is headed by:

Position Title:(please supply information)

19. [For Cities and 1st-3rd Mun. only] The LGU has
established a Teen Center (community or school-based) Yes
based on Certified Form 2E(please tick as appropriate) No

If yes, please supply the following information:

Name of Center: (please supply information)

Date established (dd/mm/yyyy): (please supply

information)

[END OF SOCIAL PROTECTION AND SENSITIVITY]

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Date: _______________________________

RAT Leader

Signature over Printed Agency/Organization

Name

RAT Member

Signature over Printed Agency/Organization

Name

RAT Member

Signature over Printed Agency/Organization

Name

Official Release of this Form: (Please affix release stamp of DILG RO/PO here)

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